To the Bone

189 Pages·2003·0.8 MB·English

by  Neil McMahon

Synopsis
Late one hot summer night, a beautiful young actress named Eden Hale --
only hours removed from breast-augmentation surgery, and writhing in pain --
stumbles to the telephone and dials 911. Within minutes, an ambulance rushes
her to San Francisco's Mercy Hospital. But by the time she arrives, she is dying,
fast, of a mysterious, unrecognizable condition.
Dr. Carroll Monks, the ER physician on duty, races to sort through her
baffling symptoms in the few minutes he has left to save her. Monks has a
sudden insight and, against the advice of his peers, risks a radical treatment,
which will prove to be either a brilliant maneuver or a potentially deadly
mistake. It fails. Eden Hale, vibrantly healthy and barely twenty-five years old,
is dead.
The fallout is immediate and intense. The plastic surgeon who operated on
Eden -- Dr. D. Welles D'Anton, whose reputation as a surgical guarantor of
perfection and agelessness has conferred on him a guru-like status -- blames
Monks for her death. Criticism from Monks's hospital colleagues quickly
follows and the threat of a lawsuit is not far behind. Monks's career is in
jeopardy, but his own guilt and uncertainty are what haunt him worst of all.
Convinced there's a hidden cause to Eden's death, Monks starts to delve into
her past. Despite roadblocks that spring up in his path, he soon learns that the
former prom queen was not the all-American girl she seemed to be: she was
caught up in the world of pornography, and was even, possibly, having an illicit
affair with D'Anton. Then Monks uncovers a secret that is far more frightening:
other young women in D'Anton's care have wound up missing, dead, or horribly
disfigured.
In his search for the truth, Monks is drawn into a culture of unimaginable
wealth and vanity -- only to discover that he is being used as a pawn in a
decadent game of glamour and cruelty, one that places him in the crosshairs of a
deadly psychopath.

To The Bone
The Third Book in the
Carroll Monks Series
A Novel by
Neil McMahon
Copyright (c) 2003 by Neil McMahon

For Drs. Barbara and Dan McMahon
Heart empowers mind
Mind informs heart

She was not old, nor young, nor at the years
Which certain people call a "certain age,"
Which yet the most uncertain age appears.
--Lord Byron

Prologue

A feverish tormenting dream of fire, spreading through her, forced her
awake. She was in bed, knees drawn up to her chest, hands clenched tightly. The
apartment was dark and still. The overhead fan whispered, cooling the air, but
the sheets were soaked with sweat. Her blurred eyes could just make out the
glowing red numbers on the alarm clock: 3:18 a.m.
The fire stayed behind in the dream, but the pain was real. She twisted with
nausea, moaning.
"Ray?" she whispered. Her throat was parched, her voice hoarse. "Is anyone
here?"
Nothing stirred in the darkened rooms. Her mind was foggy from drugs, but
she remembered that the boyfriend who was supposed to stay with her had gone
out for cigarettes. Someone else had stopped by after that-someone kind, feeding
her soup and more painkillers, that had eased her into sleep.
But that was hours ago. The pain had been only in her breasts then, but now
it was everywhere-fierce cramping and burning that worsened in quick stages,
like the tightening of a vise.
She focused her teary vision on the phone, on her bedside table. It was out of
reach, and the thought of moving was intolerable. But the pain pierced like
shards of glass. Sobbing, still curled up tight, she inched across the endless
expanse of bedsheet. As she groped for the phone, an image flitted through her
brain, a memory or dream as she had drifted into sleep, of hands disconnecting
and lifting away her answering machine.
Her fingers found the receiver and pressed the lighted numbers 911.
"Please help me," she managed, to the operator's crisp answer. "I need an
ambulance." She gasped out the syllables of her address.
Then she dropped the phone, distantly aware of the concerned voice saying,
"Ma'am? Ma'am? Are you there?"
She tightened back into herself, hugging her knees with all her strength as if
she could compress her body into a point so tiny, the agony would have no place
to remain.
It remained.
But then, inside her mind, she glimpsed a hazy image, like a window
opening up. Someone was on the other side-a taffy-haired teenaged girl, dancing
alone in front of a full-length mirror. She was bold, saucy, her movements
graceful and provocative. The girl was herself, she realized, ten years ago,
already showing the earthy beauty that she would grow into.
When the chance had come to make that beauty perfect -- to turn herself into
a different person, a better one-she had taken it.
Who wouldn't have? she silently asked her younger self. Why should that
have led to this?
The girl ignored her, continuing to prance, absorbed in her own reflected
promise.
The window was getting brighter and closer, with thousands more images
springing up, a swirling videotape of her life fast-forwarded into a few instants,
and yet all perfectly clear. She knew that she could step through, into it -- that
that would free her from this nightmare. But if she did, there would be no
coming back.
In the distance, she heard a siren.
Chapter 1

"Mercy ER, this is Medic Twelve with Code Three traffic."
The voice, choppy with static and backed by a wailing siren, came over
Mercy Hospital's paramedic radio, from an ambulance out on the San Francisco
streets. Code Three meant that it was racing toward the hospital as fast as the
night allowed.
The Mobile Intensive Care nurse monitoring the radio leaned closer and
pressed the talk button on the handset.
"Medic Twelve, this is Mercy ER," she said. "Go ahead."
Carroll Monks walked across the Emergency Room and stood beside her,
listening.
"Mercy ER, we're bringing you a young white female, age approximately
twenty-five. She's unconscious, with almost no blood pressure. She does have a
very weak femoral pulse, but no radial pulses. Ah, hold on a second, Mercy."
Monks heard the driver yell something to his partner in the ambulance's rear.
His words and the reply were lost in noise.
The driver's voice came back on. "We haven't been able to start an IV. We
can't find any veins. Repeat, she does not have an IV running. She has
respiratory depression and we are oxygenating her."
The nurse said, "Medic Twelve, do you have any history on her?"
"Negative, Mercy, not much. She was in an apartment, alone. Looks like
she's had a recent surgery, probably her breasts. We found some Valium, but we
don't think it's an overdose."
"Who called her in?"
"She managed to call 911. We got sent by City Triage."
Monks took the microphone from the nurse, and said, "Any signs of massive
bleeding?"
"There's some vomit with blood in it," the driver rasped through the static.
"But not massive."
"Nothing from the surgery? Other external wounds? Blood around the
apartment, or in the bathroom?"
"Negative, Mercy," the driver said again.
Monks's mind started tracking a flow chart of probabilities, for a young
woman who was bleeding badly, with the blood staying inside her. None of them
were good.
The nurse watched him questioningly, a look asking if he wanted any more
information. He shook his head, giving her instructions as he handed her the
microphone.
'Take her directly to the trauma room, Medic Twelve," she said.
"Roger, Mercy. ETA is six minutes."
Monks turned back to the ER and the next pressing task-organizing who was
going to need to be where, during the next half hour. Screws had been tightening
in his head all night, and this had the feel of being the most severe one yet.
It was 3:51, an early Friday morning in July. San Francisco was going
through a heat wave, with temperatures that had hovered in the nineties for the
past several days. The usual cooling sea breezes and evening fog were gone,
driven off the coast by hot winds that swept through the Central Valley like
blasts from a furnace. Inland, the thermometer had been topping 110.
But inland, they were used to it. Here, the leaden air and damp armpits and
gummy asphalt underfoot were like a sudden sneaky enemy, one that worked
just below the level of consciousness. Monks could sense it in faces -- tension,
friction, as if a layer of social lubrication had been eroded by the heat. People
were rubbing too close together, and the ER had been simmering hotter as the
hours passed. It was amazing how many human beings were up, about, and in
need of medical help, all through the night.
He had just left the bedside of a seventeen-year-old girl who was giving birth
to her third baby, a process she had started some twenty minutes earlier in her
boyfriend's car. Staff were trying to get her sent to OB, but OB was busy, and the
on-call obstetrician was not yet available. It looked like the youngster was going
to appear in the ER any minute now.
In the next bed, a fat middle-aged man was doing his best to die of a heart
attack. They had shot him full of clot-busting drugs and shocked him back to life
three times, but the monitor kept quavering in the danger zone. This was tying
up two nurses and the other ER physician on duty. A cardiologist was supposed
to be on the way to take him to the Cath Lab, but cardiology was busy, too.
The knife wound in Bed Five was coming around without complications, but
during the past minutes, his voice had risen from querulous to strident and he
was becoming combative. The SFPD cops who had brought him were gone,
back on the streets to deal with their own hot night. Hospital Security would
probably have to be called to put him in restraints, but Security had their hands
full right now in the lobby. One uniformed officer was moving uneasily among
the crowd of at least twenty, while another flanked the desk where the triage
nurse worked to separate out the most gravely ill and injured. Many were in
pain, most had been waiting a long time, and there was a volatile racial mix of
young black and Hispanic males, with girlfriends or wives who looked at least as
tough as the men. Monks had been peripherally aware of a lot of restless
movement on the other side of the lobby's glass doors -- bobbing heads and
strutting bodies, a dizzying collage that made him think of a huge, many-limbed
beast about to fall into a frenzy and tear itself apart.
And now an ambulance was on its way, bringing a woman in critical
condition. At least, Monks thought, this would bring more uniforms. It might
help stabilize the tense crowd.
He stepped to the main desk. "Call City Dispatch Center," he said. "Tell them
we're going on diversion."
Leah Horvitz, the charge nurse, nodded and reached for the phone. Leah was
a fiercely competent veteran, uncowed by any situation Monks had ever seen.
But even she looked relieved. The ER would now be temporarily closed to any
more ambulances bearing the victims of shootings and stabbings, wrecks and
rapes, overdoses and organ failure and madness. The staff were already
overwhelmed -- they could barely handle what they had, and to take on anything
more could be dangerous to patients. But it was something Monks had only done
rarely, and it left an unpleasant taste. There was the unavoidable sense of letting
down the team.
He caught the eye of a magenta-uniformed nurse named Jackie Lukas and
motioned her to meet him at the Trauma Room. She was slim, ponytailed,
athletically attractive. He knew from experience that he could count on her to
stay cool.
"We've got an ambulance coming in five minutes," he said. "A woman with
no blood pressure, and they can't get an IV in her arm. I'm going to put a big tube
in her ankle vein."
"Fourteen-gauge catheter?"
"Make it IV tubing. Sterile unopened package. And a cutdown tray."
Jackie immediately turned to her work. Monks stepped into the cubicle that
housed Bed Seven and the heart attack victim. Vernon Dickhaut, the other ER
physician, was at the bedside, looking impatient at being stuck there.
"How is he?" Monks said.
"About the same. The cardiologist's on his way."
"That's good, Vernon, because I'm going to be out of it for a while. There's a
critical coming by ambulance. The ER's all yours." Vernon was a North Dakota
farmboy with lank straw-colored hair, cornflower blue eyes, and an IQ off the
charts. He had been bound for a career in surgery, until a residency rotation with
Monks had given him a taste for the ER's adrenaline and action. Monks took a
certain pride in having corrupted him, and it had paid. A couple of years ago,
Vernon would have come close to panicking at taking full charge, but now it was
a challenge he savored.
"Don't let anybody die, huh?" Monks said.
Vernon saluted with mock trepidation.
Later, many times, Monks would remember his own words.

Monks heard Medic Twelve's siren coming from blocks away. After more
than two decades in the ER, that sound still touched him with anticipation tinged
with fear, like what a journeyman fighter must feel on hearing the first-round
bell. Then it was gone, leaving him heightened and ready.
The siren died, giving way to the rumbling vibration of a large motor, and
red lights flashing outside the ER's ambulance entrance. Monks dropped his
white coat onto a chair at the nurses' station and walked quickly into Trauma
One, a cubicle with operating-room surgical lights overhead and glass-fronted
cabinets on both side walls. Jackie Lukas and two other nurses were present.
One pulled back the curtain that separated the cubicle from Trauma Two,
converting the area to one large space with two empty beds. The other nurse had
hung two IV bottles on floor stands and was connecting them to plastic tubing.
Jackie pulled a tray from a cabinet and stripped off the sealed plastic
covering. She placed it on a Mayo stand, careful not to touch anything sterile,
and gave Monks a packet of rubber gloves, size 71/2. Monks tore it open and
gloved his hands with automatic precision. Then he started selecting and
arranging equipment from the cutdown tray. He scissored the end off a three-foot
plastic IV tube, angling the cut, then snipping off its sharp point. Jackie took the
other end and attached it to an IV bottle.
"Get lab down here right away," he told the other nurses. "I want a full